Prognosis and Circumferential Margin in Patients with Resected Hilar Cholangiocarcinoma

Stremitzer, Stefan; Stift, Judith; Laengle, Johannes; Schwarz, Christoph; Kaczirek, Klaus; Jones, Robert; Quinn, Leonard; Fenwick, Stephen; Díaz-Nieto, Rafael; Poston, Graeme J.; Malik, Hassan

doi:10.1245/s10434-020-09105-1

Cited by 10 publications

(8 citation statements)

References 16 publications

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“…A similar approach to subgroups partition in patients who underwent R1 resection was adopted by Stremitzer et al [ 23 ] in their analysis on isolated positive circumferential margin in PHC resection. In this study, though, resection margins were differently categorised.…”

Section: Discussionmentioning

confidence: 99%

Impact of Positive Radial Margin on Recurrence and Survival in Perihilar Cholangiocarcinoma

D’Amico

Mescoli

Caregari

et al. 2022

Cancers

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In resected perihilar cholangiocarcinoma (PHC), positive ductal margin (DM) is associated with poor survival. There is currently little knowledge about the impact of positive radial margin (RM) when DM is negative. The aim of this study was to evaluate the incidence and the role of positive RM. Patients who underwent surgery between 2005 and 2017 where retrospectively reviewed and stratified according to margin positivity: an isolated RM-positive group and DM ± RM group. Of the 75 patients identified; 34 (45.3%) had R1 resection and 17 had positive RM alone. Survival was poorer in patients with R1 resection compared to R0 (p = 0.019). After stratification according to margin positivity; R0 patients showed better survival than DM ± RM-positive patients (p = 0.004; MST 43.9 vs. 23.6 months), but comparable to RM-positive patients (p = 0.361; MST 43.9 vs. 39.5 months). Recurrence was higher in DM ± RM group compared to R0 (p = 0.0017; median disease-free survival (DFS) 15 vs. 30 months); but comparable between RM and R0 group (p = 0.39; DFS 20 vs. 30 months). In univariate and multivariate analysis, DM positivity resulted as a negative prognostic factor both for survival and recurrence. In conclusion, positive RM resections appear to have different recurrence patterns and survival rates than positive DM resections.

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Section: Discussionmentioning

confidence: 99%

Impact of Positive Radial Margin on Recurrence and Survival in Perihilar Cholangiocarcinoma

D’Amico

Mescoli

Caregari

et al. 2022

Cancers

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“…Stremitzer et al [ 17 ] sought to investigate the prognostic role of the isolated positive periductal dissection margin by retrospectively reviewing the data of 83 patients from two European Centers over a period of 10 year (2006–2016). The authors considered DM and hepatic transection margin as the “surgical margin” and the interface of the extrahepatic bile duct with the surrounding lymphatic/fatty tissue as the “circumferential margin”.…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Role of True Radical Resection in Perihilar Cholangiocarcinoma after Improved Evaluation of Radial Margin Status

Bellis

Mastrosimini

Conci

et al. 2022

Cancers

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Background: The evaluation of surgical margins in resected perihilar cholangiocarcinoma (PHCC) remains a challenging issue. Both ductal (DM) and radial margin (RM) should be considered to define true radical resections (R0). Although DM status is routinely described in pathological reports, RM status is often overlooked. Therefore, the frequency of true R0 and its impact on survival might be biased. Objective: To improve the evaluation of RM status and investigate the impact of true R0 on survival. Methods: From 2014 to 2020, 90 patients underwent curative surgery for PHCC at Verona University Hospital, Verona, Italy. Both DM (proximal and distal biliary margin) and RM (hepatic, periductal, and vascular margin) status were evaluated by expert hepatobiliary pathologists. Patients with lymph-node metastases or positive surgical margins (R1) were candidates for adjuvant treatment. Clinicopathological and survival data were retrieved from an institutional database. Results: True R0 were 46% (41) and overall R1 were 54% (49). RM positivity resulted in being higher than DM positivity (48% versus 27%). Overall survival was better in patients with true R0 than in patients with R1 (median survival time: 53 vs. 28 months; p = 0.016). Likewise, the best recurrence-free survival was observed in R0 compared with R1 (median survival time: 32 vs. 15 months; p = 0.006). Multivariable analysis identified residual disease status as an independent prognostic factor of both OS (p = 0.009, HR = 2.68, 95% CI = 1.27–5.63) and RFS (p = 0.009, HR = 2.14, 95% CI = 1.20–3.83). Conclusion: Excellent survival was observed in true R0 patients. The improved evaluation of RM status is mandatory to properly stratify prognosis and select patients for adjuvant treatment.

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“…Lately, a new concept of isolated circumferential margin has been introduced for pCCA. Stremitzer et al [ 80 ] identified a group of patients who, despite being classified as R1, did not have distal or proximal margin positivity but only focal circumferential positivity. These patients had better survival than those with surgical resection margin positivity, although inferior when compared to their R0 counterparts.…”

Section: Surgical Treatment: the Presentmentioning

confidence: 99%

Moving forward in the treatment of cholangiocarcinoma

Manzia¹,

Parente²,

Lenci³

et al. 2021

WJGO

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Despite being the second most frequent primary liver tumor in humans, early diagnosis and treatment of cholangiocarcinoma (CCA) are still unsatisfactory. In fact, survival after 5 years is expected in less than one fourth of patients diagnosed with this disease. Rare incidence, late appearance of symptoms and heterogeneous biology are all factors contributing to our limited knowledge of this cancer and determining its poor prognosis in the clinical setting. Several efforts have been made in the last decades in order to achieve an improved classification/understanding with regard to the diverse CCA forms. Location within the biliary tree has helped to distinguish between intrahepatic, perihilar and distal CCA types. Sequence analysis contributed to identifying several characteristic genetic aberrations in CCA that may also serve as possible targets for therapy. Novel findings are expected to significantly improve the management of this malignancy in the near future. In this changing scenario our review focuses on the current and future strategies for CCA treatment. Both systemic and surgical treatments are discussed in detail. The results of the main studies in this field are reported, together with the ongoing trials. The current findings suggest that an integrated multidisciplinary approach to this malignancy would be helpful to improve its outcome.

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Prognosis and Circumferential Margin in Patients with Resected Hilar Cholangiocarcinoma

Cited by 10 publications

References 16 publications

Impact of Positive Radial Margin on Recurrence and Survival in Perihilar Cholangiocarcinoma

Impact of Positive Radial Margin on Recurrence and Survival in Perihilar Cholangiocarcinoma

The Prognostic Role of True Radical Resection in Perihilar Cholangiocarcinoma after Improved Evaluation of Radial Margin Status

Moving forward in the treatment of cholangiocarcinoma

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